Provider Demographics
NPI:1457492449
Name:DFW CONSOLIDATED HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:DFW CONSOLIDATED HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZIE-KALU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-287-8300
Mailing Address - Street 1:1201 N KAUFMAN ST
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-2813
Mailing Address - Country:US
Mailing Address - Phone:972-287-8300
Mailing Address - Fax:972-287-1882
Practice Address - Street 1:1201 N KAUFMAN ST
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-2813
Practice Address - Country:US
Practice Address - Phone:972-287-8300
Practice Address - Fax:972-287-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011892251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013584Medicaid
TX001013584Medicaid